The Effect of Carbamazepine and Sodium Valproate on the Blood and Serum Values of Children From a Third-World Environment

Abstract

In third-world countries many children with epilepsy also suffer from malnutrition, anemia, liver disease, and immunosuppression. Doctors might have reservations about the use of anticonvulsants that could aggravate these disorders. The purpose of this study was to establish the prevalence of abnormal blood and serum values in children receiving carbamazepine or sodium valproate as monotherapy who attended a child neurology clinic serving a third-world community in Cape Town, South Africa Blood samples were taken at routine follow-up visits from 104 children who had been on carbamazepine or sodium valproate monotherapy for at least 6 months. Hematology, serum chemistry, immunoglobulins, and anticonvulsant levels were measured by standard laboratory procedures. Very few subjects had any values outside accepted normal ranges. When clinically indicated and available, carbamazepine and sodium valproate can be prescribed for children from a third-world environment. Frequent blood and serum testing is not necessary in asymptomatic individuals.

Immunoglobulins in children with epilepsy: the Dutch Study of Epilepsy in Childhood

“…In addition, in children on monotherapy with valproic acid, IgA decreased to normal levels. Data in the literature on the effect of valproic acid on the concentration of serum Ig classes are scarce and even lacking when IgG subclasses are concerned [14–16,26,27]. Although the same constraints hold for these studies as indicated above for the studies on carbamazepine, the common observation arose in these studies that the concentrations of the major Ig isotypes in serum are unaffected in patients treated with valproic acid.…”

“…Many reports have been published concerning the effects of the treatment with anti‐epileptic drugs (AEDs), e.g. phenytoin [6–9], carbamazepine [10–13] and valproic acid [14–16], on humoral and cellular immunity. From these studies, it became clear that a reversible induction of a selective IgA deficiency might occur in some patients receiving phenytoin [8], and that carbamazepine medication might be associated with selective reduction of the IgG2 subclass concentration [11].…”

Valproate-induced immune alterations in children with focal seizures

“…Lenti et al [20] found no significant difference with respect to the IgA, IgG and IgM serum levels among untreated patients, patients on sodium valproate or carbamazepine monotherapy and the controls. Likewise, Hemingway et al [21] found no significant deviation in IgA, IgM and IgG serum concentrations from the accepted normal ranges in patients receiving either carbamazepine or sodium valproate as monotherapy. The aforementioned data seem to be conflicting, and we postulate that the heterogeneity of the previously mentioned studies regarding age of the study subjects, clinical type of epilepsy, type of AEDs and whether used as monotherapy or poly-therapy and age at onset of seizures could possibly account for this discrepancy.…”

“…Changes in humoral immune responses and serum immunoglobulin concentrations in epileptic patients have been reported since the 1970s [17]. However, published human data on the effect of sodium valproate on immunoglobulin serum levels are scarce, and results from different studies are inconsistent and sometimes conflicting [17][18][19][20][21]. This is perhaps due to heterogeneity of the studied populations regarding gender, age and/or type of epilepsy.…”

Anemia secondary to valproic acid therapy in a 13-year-old boy: a case report

“…Some of the patients previously documented had undergone relatively longer treatment [1]. Some of them had been treated with higher doses of valproate [9], and some had been taking other anticonvulsants [10] or other additional medications [11]. Our patient presented with normocellular bone marrow with qualitative abnormalities of erythropoiesis, whereas other authors have presented cases of patients with severe abnormalities of the bone marrow, such as hypocellularity, myelodysplasia, and changes resembling promyelocytic leukemia as well [1,3,12].…”